Public long-term care (LTC) systems provide services to support people experiencing difficulties with their activities of daily living. This study investigates the marginal effect of changes in public LTC expenditure on care-related quality of life (CRQoL) of existing service users in England. The public LTC program for people aged 18 or older in England is called Adult Social Care (ASC) and it is provided and managed by local authorities. We collect data on the outcomes and characteristics of public ASC users, on public ASC expenditure, and on the characteristics of local authorities across England in 2017/18. We employ an instrumental variable approach using conditionally exogenous elements of the public funding system to estimate the effect of public ASC expenditure on user CRQoL. Our findings show that by increasing public ASC expenditure by £1000 per user, on average, local authorities increase user CRQoL by 0.0030. These results suggest that public ASC is effective in increasing users' quality of life but only to a relatively small extent. When combined with the other potential effects of LTC expenditure (e.g., on informal carers, mortality), this study can inform policy makers in the United Kingdom and internationally about whether social care provides good value for money.

中文翻译：

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公共长期护理支出是否改善了英格兰服务使用者的护理相关生活质量？

公共长期护理 (LTC) 系统提供服务以支持在日常生活活动中遇到困难的人们。本研究调查了公共 LTC 支出变化对英格兰现有服务用户的护理相关生活质量 (CRQoL) 的边际影响。在英格兰，面向 18 岁或以上人士的公共 LTC 计划称为成人社会关怀 (ASC)，由地方当局提供和管理。我们收集了关于公共 ASC 用户的结果和特征、公共 ASC 支出以及 2017/18 年英格兰各地地方当局特征的数据。我们采用工具变量方法，使用公共资金系统的条件外生要素来估计公共 ASC 支出对用户 CRQoL 的影响。我们的研究结果表明，通过将每个用户的公共 ASC 支出增加 1000 英镑，地方当局平均将用户 CRQoL 增加 0.0030。这些结果表明公共 ASC 在提高用户的生活质量方面是有效的，但只是在相对较小的程度上。当与 LTC 支出的其他潜在影响（例如，对非正式护理人员、死亡率）相结合时，这项研究可以告知英国和国际的决策者社会护理是否物有所值。